Dentistry and the Pregnant Patient www.pdflobby.com Ninan_Frontmatter.indd 2/28/18 11:23 AM www.pdflobby.com Ninan_Frontmatter.indd 2/28/18 11:23 AM Dentistry Pregnant Patient and the Daniel Ninan, dds Assistant Professor Dental Education Services School of Dentistry Loma Linda University Loma Linda, California With contributions from R Leslie Arnett, dds, ms Sheila Bahn, md Brinda Grapin, pharmd Bates D Moses, md Berlin, Barcelona, Chicago, Istanbul, London, Milan, Moscow, New Delhi, Paris, Prague, São Paulo, Seoul, Singapore, Tokyo, Warsaw www.pdflobby.com Ninan_Frontmatter.indd 2/28/18 11:23 AM This book is dedicated to my amazing family: Priscilla, Norman, Pat, Bonnie, Ben, Barbara, David, Stacy, Debbie, Kayli, and Khloe Thank you for always supporting my pursuits I also extend this dedication to those who have touched my life and inspired me to make this world a better place Library of Congress Cataloging-in-Publication Data Names: Ninan, Daniel, author Title: Dentistry and the pregnant patient / Daniel Ninan Description: Hanover Park, IL : Quintessence Publishing Co Inc, [2018] | Includes bibliographical references and index Identifiers: LCCN 2017058024 (print) | LCCN 2017059740 (ebook) | ISBN 9780867157802 (ebook) | ISBN 9780867157796 (softcover) Subjects: | MESH: Dental Care | Pregnant Women Classification: LCC RK56 (ebook) | LCC RK56 (print) | NLM WU 29 | DDC 617.6 dc23 LC record available at https://lccn.loc.gov/2017058024 97% © 2018 Quintessence Publishing Co, Inc Quintessence Publishing Co, Inc 4350 Chandler Drive Hanover Park, IL 60133 www.quintpub.com 5 4 3 2 1 All rights reserved This book or any part thereof may not be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, or otherwise, without prior written permission of the publisher Editor: Marieke Zaffron Design: Sue Zubek Production: Angelina Schmelter Printed in the USA www.pdflobby.com Ninan_Frontmatter.indd 2/28/18 11:23 AM Contents Preface vi  erceptions About Dental Treatment P During Pregnancy 1 Considerations for Treating Pregnant Patients 5 Complications and the Impact on Dental Care 19 Procedures and Treatment Guidelines 57 Administration of Drugs During Pregnancy 77 Medications 85 Anesthetic Use 115 Appendices 133 Index 147 www.pdflobby.com Ninan_Frontmatter.indd 2/28/18 11:23 AM Preface My Introduction to the Treatment of Pregnant Women Early in life, I became aware of the fear and caution that can envelop health care practitioners when they are placed in a situation where they have to evaluate and treat a pregnant woman My mother, a labor and delivery nurse, told me stories about her experiences One time, the emergency room staff immediately transferred a patient to the labor and delivery unit upon finding out she was pregnant—without even assessing the chief complaint that brought her to the emergency room in the first place It is likely that the emergency room staff had reservations about treating a pregnant woman without first obtaining a specialist’s opinion I have observed what appears to be a similar fear from dental professionals who are reluctant to treat pregnant patients Many dentists may fear that they may cause harm to the unborn baby or the expectant mother.1 The Role of Dentistry During Pregnancy As dental professionals, our duty is to find ways to provide necessary dental care as safely as possible Our ideal role is to work with a woman to help her get to a state of ideal oral health before she becomes pregnant This way, the need for invasive treatments during pregnancy is minimized or prevented altogether Researchers keep uncovering evidence that untreated oral disease has the potential to be detrimental to both the expectant mother and the baby Poor oral health is associated with a number of pregnancy-related complications, including the following: • • • • • • Preterm delivery2 Low birth weight2,3 Preeclampsia2,4 Gestational diabetes3 Fetal loss5 Childhood caries as a result of maternal cariogenic bacterial load6 Unfortunately, there is a large proportion of pregnant women who have significant unmet oral health care needs Many women either fail to seek or are unable to receive dental treatment based on concerns regarding its safety during pregnancy It is understandable for providers to have reservations about treating patients in need, and careful consideration should be given to every circumstance Currently, there is limited clinical vi www.pdflobby.com Ninan_Frontmatter.indd 2/28/18 11:23 AM Preface trial evidence to support or refute the premise that providing dental care is totally safe for the pregnant woman And while dental procedures have not been directly linked to fetal loss, it may be of importance to note that most dental procedures induce bacteremias, and subgingival bacteria has been reported to travel to the placenta and cause fetal demise.5,7 Even if all dental needs are addressed prior to pregnancy, unforeseen dental emergencies may arise that require invasive and sometimes extensive treatment during pregnancy It is also important to note that nearly 50% of women have at least one unplanned pregnancy during the course of their life It is possible that a dentist may treat some patients who not realize they are already pregnant Because of this, dental professionals should always consider the possibility of adverse fetal effect when treating a woman of childbearing age This book is a quick reference guide on how to maximize the safety of the pregnant woman and her unborn child while providing dental care Ultimately, my hope is that this will result in better outcomes for both the expectant mother and her unborn baby Acknowledgments I would first like to thank Quintessence Publishing for this opportunity I would also like to say thank you to everyone who helped As with any list of people, there are always more whose names are inadvertently omitted I am very grateful to Dan Fischer and the many suggestions he provided during this project I want to say thank you to Alexander Bahn, Natalie Barton, Richard Lynch, Cathy Presland, and Penny Swift, as well as my family for their support and guidance while writing this book References California Dental Association Foundation; American College of Obstetricians and Gynecologists, District IX Oral health during pregnancy and early childhood: Evidence-based guidelines for health professionals J Calif Dent Assoc 2010;38:391–403, 405–440 Sanz M, Kornman K, Working group of joint EFP/AAP workshop Periodontitis and adverse pregnancy outcomes: Consensus report of the Joint EFP/AAP Workshop on Periodontitis and Systemic Diseases J Periodontol 2013;84(4 suppl):S164–S169 Kentucky Cabinet for Health and Family Services Kentucky Pregnancy Risk Assessment Monitoring System (PRAMS) Pilot Project: 2008 Data Report http://chfs.ky.gov/NR/rdonlyres/888F8BBC-3DF7-47A4-B34E-8BD7BABA1E09/0/PRAMSREPORT08finalwithcovers.pdf Accessed 15 January 2018 Strafford KE, Shellhaas C, Hade EM Provider and patient perceptions about dental care during pregnancy J Matern Fetal Neonatal Med 2008;21:63–71 Han YW, Fardini Y, Chen C, et al Term stillbirth caused by oral Fusobacterium nucleatum Obstet Gynecol 2010;115:442–445 Chaffee BW, Gansky SA, Weintraub JA, Featherstone JDB, Ramos-Gomez FJ Maternal oral bacterial levels predict early childhood caries development J Dent Res 2014;93:238–244 Hilgers KK, Douglass J, Mathieu GP Adolescent pregnancy: A review of dental treatment guidelines Pediatr Dent 2003;25:459–467 vii www.pdflobby.com Ninan_Frontmatter.indd 2/28/18 11:23 AM CHAPTER Perceptions About Dental Treatment During Pregnancy www.pdflobby.com Ninan_CH01.indd 2/28/18 11:24 AM Key Points • Prenatal care providers often not discuss oral health with their patients or provide dental referrals.1 • Dentists not always provide treatment during pregnancy because of poor perceptions of treatment safety.2 • Pregnant women often not seek dental care because they believe it is unsafe.3,4 Most women not see a dentist during their pregnancy, but the consequence of not treating oral pathologies can be devastating.1,5 Perceptions of the safety of dental treatment during pregnancy by patients, dental providers, and prenatal providers may all contribute to the lack of oral health care during pregnancy.1,6 Prenatal Care Provider Perceptions In 1992, it was reported that 91% of obstetricians did not want to be consulted before dental treatment unless the treatment might induce a bacteremia.7 If they believed a bacteremia might occur, 79% of the obstetricians wanted to be consulted prior to treatment.7 The conflict, which suggests insufficient understanding of dental treatment, is that most routine dental procedures have been well documented to induce a transient bacteremia Examples of procedures that induce bacteremia include tooth extraction, gingivectomy, supra- and subgingival scaling, ultrasonic scaling, and subgingival irrigation.8 In a 2012 study, it was reported that obstetricians were well informed on the relationship between periodontal disease and pregnancy outcomes.1 However, at the same time, many prenatal general practitioners and midwives may not understand the link between oral health and overall health.1 The authors of the study also found that most of the time, prenatal care providers did not discuss oral health with their patients and that dental referrals were often only made when the patient self-identified an oral health problem.1 Other researchers www.pdflobby.com Ninan_CH01.indd 2/28/18 11:24 AM Appendix B B2: American Dental Association Caries Risk Assessment Form (Age 0-6) Patient Name: Birth Date: Date: Age: Initials: Low Risk Contributing Conditions Moderate Risk High Risk Check or Circle the conditions that apply I Fluoride Exposure (through drinking water, supplements, professional applications, toothpaste) II Sugary Foods or Drinks (including juice, carbonated or non-carbonated soft drinks, energy drinks, medicinal syrups) III Eligible for Government Programs (WIC, Head Start, Medicaid or SCHIP) IV Caries Experience of Mother, Caregiver and/ or other Siblings No carious lesions in last 24 months ❑ Carious lesions in last 7-23 months ❑ V Dental Home: established patient of record in a dental office Yes ❑ No ❑ I Special Health Care Needs (developmental, physical, medical or mental disabilities that prevent or limit performance of adequate oral health care by themselves or caregivers) I Visual or Radiographically Evident Restorations/Cavitated Carious Lesions No new carious lesions or restorations in last 24 months ❑ Carious lesions or restorations in last 24 months ❑ II Non-cavitated (incipient) Carious Lesions No new lesions in last 24 months ❑ New lesions in last 24 months ❑ III Teeth Missing Due to Caries No ❑ Yes ❑ IV Visible Plaque No ❑ Yes ❑ V Dental/Orthodontic Appliances Present (fixed or removable) No ❑ Yes ❑ VI Salivary Flow Yes ❑ No ❑ Primarily at mealtimes ❑ Frequent or prolonged between meal exposures/day ❑ No ❑ General Health Conditions Yes ❑ Carious lesions in last months ❑ Check or Circle the conditions that apply No ❑ Clinical Conditions Overall assessment of dental caries risk: Bottle or sippy cup with anything other than water at bed time ❑ Yes ❑ Check or Circle the conditions that apply Visually adequate ❑ ❑ Low Visually inadequate ❑ ❑ Moderate ❑ High Instructions for Caregiver: Copyright © 2018 American Dental Association All rights reserved Reprinted with permission 139 www.pdflobby.com Ninan_Appendices.indd 139 2/28/18 11:39 AM Appendix B: Caries Risk Assessment Forms Caries Risk Assessment Form (Age >6) Patient Name: Birth Date: Date: Age: Initials: Low Risk Contributing Conditions Moderate Risk Check or Circle the conditions that apply I Fluoride Exposure (through drinking water, supplements, professional applications, toothpaste) II Sugary Foods or Drinks (including juice, carbonated or non-carbonated soft drinks, energy drinks, medicinal syrups) III Caries Experience of Mother, Caregiver and/or other Siblings (for patients ages 6-14) IV Dental Home: established patient of record, receiving regular dental care in a dental office Yes ❑ No ❑ Frequent or prolonged between meal exposures/day ❑ Primarily at mealtimes ❑ No carious lesions in last 24 months ❑ Carious lesions in last 7-23 months ❑ Yes ❑ No ❑ General Health Conditions Carious lesions in last months ❑ Check or Circle the conditions that apply I Special Health Care Needs (developmental, physical, medical or mental disabilities that prevent or limit performance of adequate oral health care by themselves or caregivers) No ❑ II Chemo/Radiation Therapy No ❑ III Eating Disorders No ❑ Yes ❑ IV Medications that Reduce Salivary Flow No ❑ Yes ❑ V Drug/Alcohol Abuse No ❑ Yes ❑ Clinical Conditions Yes (over age 14) ❑ Yes (ages 6-14) ❑ Yes ❑ Check or Circle the conditions that apply I Cavitated or Non-Cavitated (incipient) Carious Lesions or Restorations (visually or radiographically evident) II Teeth Missing Due to Caries in past 36 months No ❑ III Visible Plaque No ❑ Yes ❑ IV Unusual Tooth Morphology that compromises oral hygiene No ❑ Yes ❑ V Interproximal Restorations - or more No ❑ Yes ❑ VI Exposed Root Surfaces Present No ❑ Yes ❑ VII Restorations with Overhangs and/or Open Margins; Open Contacts with Food Impaction No ❑ Yes ❑ VIII Dental/Orthodontic Appliances (fixed or removable) No ❑ Yes ❑ IX Severe Dry Mouth (Xerostomia) No ❑ Overall assessment of dental caries risk: High Risk No new carious lesions or restorations in last 36 months ❑ ❑ Low or new carious lesions or restorations in last 36 months ❑ or more carious lesions or restorations in last 36 months ❑ Yes ❑ Yes ❑ ❑ Moderate ❑ High Patient Instructions: 140 www.pdflobby.com Ninan_Appendices.indd 140 2/28/18 11:39 AM Appendix C Appendix C: US Food and Drug Administration Recommendations for Prescribing Dental Radiographs These recommendations are subject to clinical judgment and may not apply to every patient They are to be used by dentists only after reviewing the patient’s health history and completing a clinical examination Even though radiation exposure from dental radiographs is low, once a decision to obtain radiographs is made, it is the dentist’s responsibility to follow the ALARA principle (as low as reasonably achievable) to minimize the patient’s exposure Type of encounter Patient age and dental developmental stage Child with Primary Dentition (prior to eruption of first permanent tooth) Child with Transitional Dentition (after eruption of first permanent tooth) Adolescent with Permanent Dentition (prior to eruption of third molars) Adult, Dentate or Partially Edentulous Adult, Edentulous New patient* being evaluated for oral diseases Individualized radiographic exam consisting of selected periapical/occlusal views and/or posterior bitewings if proximal surfaces cannot be visualized or probed Patients without evidence of disease and with open proximal contacts may not require a radiographic exam at this time Recall patient* with clinical caries or at increased risk for caries† Posterior bitewing exam at 6- to 12-month intervals if proximal surfaces cannot be examined visually or with a probe Posterior bitewing exam at 6- to 18-month intervals Not applicable Recall patient* with no clinical caries and not at increased risk for caries† Posterior bitewing exam at 12- to 24-month intervals if proximal surfaces cannot be examined visually or with a probe Posterior bitewing exam at 24- to 36-month intervals Not applicable Recall patient* with periodontal disease Clinical judgment as to the need for and type of radiographic images for the evaluation of periodontal disease Imaging may consist of, but is not limited to, selected bitewing and/or periapical images of areas where periodontal disease (other than nonspecific gingivitis) can be demonstrated clinically Patient (new and recall) for monitoring of dentofacial growth and development, and/or assessment of dental/skeletal relationships Clinical judgment as to need for and type of radiographic images for evaluation and/or monitoring of dentofacial growth and development or assessment of dental and skeletal relationships Patient with other circumstances including, but not limited to, proposed or existing implants, other dental and craniofacial pathoses, restorative/endodontic needs, treated periodontal disease and caries remineralization Clinical judgment as to need for and type of radiographic images for evaluation and/or monitoring of these conditions Individualized radiographic exam consisting of posterior bitewings with panoramic exam or posterior bitewings and selected periapical images Individualized radiographic exam consisting of posterior bitewings with panoramic exam or posterior bitewings and selected periapical images A full-mouth intraoral radiographic exam is preferred when the patient has clinical evidence of generalized oral disease or a history of extensive dental treatment Posterior bitewing exam at 18- to 36-month intervals Same as children, plus panoramic or periapical exam to assess developing third molars Individualized radiographic exam, based on clinical signs and symptoms Not applicable Usually not indicated for monitoring of growth and development Clinical judgment as to the need for and type of radiographic image for evaluation of dental and skeletal relationships 141 www.pdflobby.com Ninan_Appendices.indd 141 2/28/18 11:39 AM Appendix C: US Food and Drug Administration Recommendations *Clinical situations for which radiographs may be indicated include, but are not limited to: • Positive historical findings: ‒‒ Previous periodontal or endodontic treatment ‒‒ History of pain or trauma ‒‒ Familial history of dental anomalies ‒‒ Postoperative evaluation of healing ‒‒ Remineralization monitoring ‒‒ Presence of implants, previous implant-related pathosis, or evaluation for implant placement • Positive clinical signs/symptoms: ‒‒ Clinical evidence of periodontal disease ‒‒ Large or deep restorations ‒‒ Deep caries lesions ‒‒ Malposed or clinically impacted teeth ‒‒ Swelling ‒‒ Evidence of dental/facial trauma ‒‒ Mobility of teeth ‒‒ Sinus tract (“fistula”) ‒‒ Clinically suspected sinus pathosis ‒‒ Growth abnormalities ‒‒ Oral involvement in known or suspected systemic disease ‒‒ Positive neurologic findings in the head and neck ‒‒ Evidence of foreign objects ‒‒ Pain and/or dysfunction of the temporomandibular joint ‒‒ Facial asymmetry ‒‒ Unexplained bleeding ‒‒ Unexplained sensitivity of teeth ‒‒ Unusual eruption, spacing, or migration of teeth ‒‒ Unusual tooth morphology, calcification, or color ‒‒ Unexplained absence of teeth ‒‒ Clinical tooth erosion ‒‒ Peri-implantitis † Factors increasing risk for caries may be assessed using the ADA Caries Risk Assessment forms (0– years of age and > years of age) 142 www.pdflobby.com Ninan_Appendices.indd 142 2/28/18 11:39 AM Appendix D Appendix D: Prescription Writing Overview Typical elements of a prescription • • • • • • Doctor’s name, address, and phone number Patient’s name, address, and date of birth Date Rx: Drug name, dosage, form, and size Disp: How much of the drug to be dispensed Sig: Directions for how the patient should take the drug ‒‒ Include route of administration ‒‒ Include when to stop taking For example, “as needed for pain” or “until gone.” ‒‒ Consider including the purpose of the medication to help educate the patient For example, take “to treat oral infection.” ‒‒ Example: “Take one tablet by mouth three times a day until finished to treat infection.” • Fill generic (OK to substitute with generic) / Fill as written (Do not substitute) • Doctor’s signature, state license number, Drug Enforcement Agency number (as required) Common prescription writing abbreviations When in doubt, write it out Abbreviation i, ii, iii b Meaning one, two, three Abbreviation q twice Meaning four (note: same abbreviation as “every”) twice a day qAM in the morning d day qhs at bedtime h hours qid four times a day po by mouth/orally qPM in the evening prn as needed stat immediately bid q every (eg, q6h means every hours) t tid three three times a day 143 www.pdflobby.com Ninan_Appendices.indd 143 2/28/18 11:39 AM Appendix E: Recommended Web Resources Appendix E: Recommended Web Resources Academy of Nutrition and Dietetics The Academy of Nutrition and Dietetics’s award-winning eatright.org brings consumers the latest science-based nutrition information This site offers additional information on nutrition during pregnancy and provides a resource to locate a dietitian All content on the eatright websites is copyrighted by the Academy of Nutrition and Dietetics http://www.eatright.org American Academy of Pediatric Dentistry Caries risk assessment http://www.aapd.org/media/Policies_Guidelines/G_CariesRiskAssessment.pdf Guideline on informed consent http://www.aapd.org/media/Policies_Guidelines/G_InformedConsent.pdf Guideline on oral health care for the pregnant adolescent http://www.aapd.org/media/Policies_Guidelines/G_Pregnancy.pdf Guideline on periodicity of examination, preventive dental services, anticipatory guidance/counseling, and oral treatment for infants, children, and adolescents http://www.aapd.org/media/Policies_Guidelines/G_Periodicity.pdf All items on the aapd.org website are copyright of the American Academy of Pediatric Dentistry American Dental Association Caries risk assessment tools, ages to http://www.ada.org/en/~/media/ADA_Foundation/GKAS/Files/topics-caries-educationalunder6-GKAS Caries risk assessment tools, ages over http://www.ada.org/en/~/media/ADA/Science%20and%20Research/Files/topic_caries_over6 Information on reconstituting infant formula with fluoridated water http://ebd.ada.org/~/media/EBD/Files/ADA_Evidence-based_Infant_Formula_Chairside_ Guide.ashx Collection of clinical practice guidelines http://ebd.ada.org/en/evidence/guidelines Guidelines on flossing http://www.ada.org/~/media/ADA/Science%20and%20Research/Files/watch_materials_floss pdf?la=en Guidelines on brushing http://www.mouthhealthy.org/en/az-topics/b/brushing-your-teeth 144 Unless otherwise indicated, all items on the ada.org website are protected by copyright of the American Dental Association www.pdflobby.com Ninan_Appendices.indd 144 2/28/18 11:39 AM Appendix E California Dental Association Evidence-based oral health guidelines https://www.cdafoundation.org/portals/0/pdfs/poh_guidelines.pdf All contents of the CDA Foundation web site: Copyright © 2002-2017 CDA Foundation, all rights reserved The International Lactation Consultant Association This site provides a resource for a woman to find a lactation consultant http://www.ilca.org/home The contents of all materials contained on ILCA’s website are owned by ILCA (unless otherwise indicated) and are protected by US and international copyright laws National Maternal and Child Oral Health Resource Center Home page https://www.mchoralhealth.org/ Oral health care during pregnancy: a national consensus statement https://www.mchoralhealth.org/materials/consensus_statement.php All OHRC-produced resources, including materials and websites, are copyrighted and protected by Georgetown University’s copyright policies, unless otherwise stated New York State Department of Health Oral health care during pregnancy and early childhood practice guidelines https://www.health.ny.gov/publications/0824.pdf NIH National Library of Medicine The LactMed Database contains information on drugs and other chemicals to which breastfeeding mothers may be exposed and the possible adverse effects in the nursing infant https://toxnet.nlm.nih.gov/newtoxnet/lactmed.htm US Food and Drug Administration List of pregnancy exposure registries https://www.fda.gov/ScienceResearch/SpecialTopics/WomensHealthResearch/ucm134848.htm The selection of patients for dental radiographic examinations http://www.fda.gov/Radiation-EmittingProducts/RadiationEmittingProductsandProcedures/ MedicalImaging/MedicalX-Rays/ucm116504.htm Pregnancy and lactation labeling (drugs) final rule http://www.fda.gov/Drugs/DevelopmentApprovalProcess/DevelopmentResources/Labeling/ ucm093307.htm 145 www.pdflobby.com Ninan_Appendices.indd 145 2/28/18 11:39 AM Index www.pdflobby.com Ninan_Index.indd 146 2/28/18 11:40 AM Index Page references followed by “t” denote tables and “f” denote figures A AADP See American Academy of Pediatric Dentistry AAP See American Academy of Periodontology Abortus, 10 Academy of Nutrition and Dietetics, 145 Acetaminophen, 88t, 94–95 Acetaminophen + codeine, 88t, 94–95 Acetylsalicylic acid, 89 ACOG See American College of Obstetricians and Gynecologists ADA See American Dental Association Adolescent pregnancy, 49–51 AED See Automated external defibrillator AHA See American Heart Association ALARA principle, 59 Alcohol, 67 Alkaline phosphatase, 38 Allergies, 117–118 Amalgam, 60–62 American Academy of Pediatric Dentistry, 71, 136, 144 American Academy of Periodontology, American College of Obstetricians and Gynecologists, 7, 58 American College of Radiology, 58 American Dental Association caries risk assessment forms, 139–140 toothpaste recommendations of, 71 web resources of, 144 American Heart Association, 25 Amide anesthetics, 117t, 122 Amoclan See Amoxicillin + clavulanic acid Amoxicillin, 102t, 104 Amoxicillin + clavulanic acid, 102t, 105 Analgesics acetaminophen, 88t, 94–95 acetaminophen + codeine, 88t, 94–95 aspirin, 89 aspirin + caffeine + dihydrocodeine, 95 celecoxib, 88t, 92 codeine, 90 hydrocodone + acetaminophen, 88t, 96–97 hydrocodone + ibuprofen, 88t, 97 hydromorphone, 88t, 101 ibuprofen, 88t, 93 meperidine, 88t, 100 naproxen, 91 oxycodone + acetaminophen, 88t, 99 oxycodone + aspirin, 98 summary of, 87, 88t tramadol + acetaminophen, 96 Anesthetics allergies to, 117–118 local See Local anesthetics psychogenic reactions to, 117–118 topical, 116t, 118–121 Antibiotics cephalosporins, 102t lincosamines, 102t macrolides, 102t penicillins, 102t prophylactic uses of, 64 quinolones, 102t summary of, 101, 102t–103t tetracyclines, 102t Anticipatory guidance for cariogenic bacteria, 68 in first trimester, 12 in third trimester, 14 Antiphospholipid syndrome, 22t, 36 Anxiety, dental, 21t, 24, 51 Aortocaval compression, 21t, 26, 30, 31, 32f APLS See Antiphospholipid syndrome Articaine, 116t, 117, 128 ASA See Acetylsalicylic acid Aspiration, 8–9 Aspirin, 49, 89, 98 Aspirin + caffeine + dihydrocodeine, 95 At-home oral care, 64–66 Augmentin See Amoxicillin + clavulanic acid Automated external defibrillator, 21t, 25 Azithromycin, 103t, 108 B Bacteremia, 1, 5, 9, 64 Bacteria, cariogenic, 68 Behavioral health, 21t Benzocaine, 116t, 120 Benzocaine/butamben/tetracaine, 116t, 121 Birth defects, 46 Bisphenol A, 62, 63f Bisphenol A–glycidyl methacrylate, 62, 63f Blood pressure, 29–30 BPA See Bisphenol A Braxton-Hicks contractions, 23t, 43–44 Breast milk, 49 147 www.pdflobby.com Ninan_Index.indd 147 2/28/18 11:40 AM Index Breastfeeding, 69 See also Nursing Brushing, 65 Bupivacaine, 116t, 127 C California Dental Association oral health guidelines, preeclampsia guidelines, 27 web resources of, 145 Carbocaine See Mepivacaine Cardiac output fetal, 24 maternal, 29 Cardiopulmonary arrest, 21t, 24–26, 25f Cardiopulmonary resuscitation, 25f, 25–26 Caries childhood, 40 professionally applied topical fluoride for, 70–71 Caries risk assessment description of, 34 forms for, 136–140 in infant, 70 Cariogenic bacteria, 68 CDT See Current dental terminology Celecoxib, 88t, 92 Cephalexin, 103t, 106 Cephalosporins, 102t Cesarean delivery, 26 Chlorhexidine, 14 Ciprofloxacin, 110 Circulatory system, 21t, 24–32 Citanest See Prilocaine Clarithromycin, 106 Cleft lip/palate, 47, 67 Cleocin See Clindamycin Clindamycin, 103t, 109 Clotting factors, 36t Coagulation, 14, 36–37 Codeine, 90 Composite resins, 62, 63f Comprehensive dental treatment plan, Consent, informed, 50 Consults, medical description of, forms used in, 134–135 COX2 inhibitors See Cyclooxygenase-2 inhibitors CPR See Cardiopulmonary resuscitation Creatinine clearance, 43 Current dental terminology, 71 Cyclooxygenase-2 inhibitors, 86 D Delayed gastric emptying, 33–34 Dental anxiety, 21t, 24, 51 Dental care barriers to, postpartum, 14 when to provide, Dental emergency, Dental erosion, 34–35 Dental instruments, aspiration of, Dental materials amalgam, 60–62 aspiration of, composite resin, 62, 63f fetal exposure to, 60 Dental provider’s perceptions, Dental referrals, 1, 134, 135 Dental treatment bacteremia caused by, categories of, 6–7 comprehensive plan for, consequences of, 7–8 deferral of, in minors, 51t needs for, pregnancy-related changes’ effect on, 20–23, 21t–22t radiographs effect on, 59 timing of, 8–9 trimester-based recommendations for, 12–14, 13t Dentifrice See Toothpaste Dermatologic changes, 23t, 40 Deterministic effects, of radiation, 58 Diabetes mellitus, 21t, 32–33 Diastolic blood pressure, 29 Dicloxacillin, 103t, 105 Doxylamine and pyridoxine, 35 Drugs See Anesthetics; Medications Due date estimations, 12 Dyspnea, 23t, 44–45 E Eclampsia, 21t, 27–29 Elective dental treatment, 6–7 Embryogenesis, 48 Emergency dental treatment, 6, 13t Enamel erosion/decalcification of, 23t, 41 fetal development of, 47 Endocrine system, 21t, 32–33 Epinephrine, 14, 123 148 www.pdflobby.com Ninan_Index.indd 148 2/28/18 11:40 AM Index Epistaxis See Nosebleed Epulis gravidarum, 42 Erythromycin, 103t, 107 Ester anesthetics, 117t Estrogen, 20, 32, 41, 43 F False labor, 23t, 43–44 FDA See Food and Drug Administration Fetal development anomalies of, 46 birth defects, 46 normal, 48 teratogen effects on, 46–48 Fetal erythropoiesis, 35 Fetal gastroschisis, 89 Fetal red blood cells, 24 Fetogenesis, 48 Fetus brain development in, 47 cardiac output in, 24 definition of, 46 dental material exposure by, 60 dental treatment effects on, 8–9 drug bioavailability to, 78 heart rate in, 31 hypoxia compensatory measures from, 24 local anesthetic exposure to, 121–122 loss of, 48 mercury exposure to, from amalgam, 60–61 periodontal therapy effects on, 63 radiation effects on, 58–59 First trimester, 12, 13t Flossing, 65 Fluoride in toothpaste, 72 topical, professionally applied, 70–71 in water, 67 Fluorosis, 72 Folate, 67 Food and Drug Administration dental radiograph guidelines, 141–142 Pregnancy and Lactation Labeling Rule, 78, 80–82, 81t pregnancy risk categories, 78–82 web resources of, 145 Foods, 66–67 G Gastroesophageal reflux, 22t, 33–34 Gastrointestinal system, 22t, 33–35 Gastroschisis, 89 Gestational diabetes, 21t, 32–33 Gingival crevicular fluid, 42 Gingival hyperplasia, 23t, 41–42 Gingivitis, 20, 23t, 41–42, 64 Glomerular filtration rate, 23t, 43 Glucose intolerance, 33 GTPAL, 10–11 H Heart murmurs, 21t, 30 Heart rate fetal, 31 increased, 21t, 29 Heartburn, 22t, 33–34 HELLP syndrome, 27 Hematologic system, 22t, 36–38 Hemoglobin A1c, 33 Hepatic dysfunction, 22t, 38 Hepatic system, 22t, 38 Hormones, 20, 32, 41, 43 Hydrocodone + acetaminophen, 88t, 96t, 97 Hydrocodone + ibuprofen, 88t, 97 Hydromorphone, 88t, 101 Hypercoagulable state, 3t, 14, 22t, 36–37, 122–123 Hyperemesis gravidarum, 22t, 34 Hyperglycemia, 33 Hypertension, 21t, 29 Hyperventilation, 23t, 45 Hypoglycemia, 33 Hypotension, 21t, 29–30 Hypoxia, 24 I Iatrogenic-related complications, Ibudone See Hydrocodone + ibuprofen Ibuprofen, 88t, 93 ILE See Intravenous lipid emulsion Immune system, 22t, 39–40 Immunoglobulin G, 22t, 39 Infant caries risk assessment in, 70 cariogenic bacteria exposure, 68 cleaning of teeth, 71 dietary recommendations for, 69 maternal medication transfer to, during nursing, 49 oral care for, 69 toothpaste for, 71–72, 71t, 72f Infant formula, 69 Inferior vena cava compression, 31, 32f 149 www.pdflobby.com Ninan_Index.indd 149 2/28/18 11:40 AM Index Informed consent, 50 Inorganic mercury, 60 Integumentary system, 23t, 40 Interdental cleaners, 65 Interdental papilla, 41–42 Intravenous lipid emulsion, 123 K Keflex See Cephalexin L Lactation FDA Pregnancy and Lactation Labeling Rule, 78, 80–82, 81t local anesthetic use during, 123 Last menstrual period, for due date estimation, 12 Left uterine displacement, 21t, 26, 30–32, 32f, 52 Levonordefrin, 123 Lidocaine characteristics of, 116t, 124 with epinephrine, 122–123 topical, 118 Lidocaine + prilocaine, 119 Lincosamines, 102t Liver dysfunction, 22t, 38 Local anesthetics amide, 122 in dental cartridge, 116 epinephrine in, 38 fetal exposure to, 121–123 intravenous lipid emulsion for toxicity caused by, 123 during lactation, 123 placental transfer of, 122–123 in postpartum period, 122–123 toxicity to, 123 types of, 116t Loss, fetal, 48 LUD See Left uterine displacement M Macrolides, 102t Marcaine See Bupivacaine “Mask of pregnancy.” See Melasma “Mature minor” laws, 50 Medical consults description of, forms used in, 134–135 Medications analgesics See Analgesics bioavailability of, to fetus, 78 FDA pregnancy risk categories for, 78–82 nonsteroidal anti-inflammatory drugs, 86 during nursing, 78 opioids, 87 over-the-counter, 79 placental passage of, 78 prescription writing for, 143 selection of, 77 Melasma, 23t, 40 Meperidine, 88t, 100 Mepivacaine, 116t, 125 Mercury in amalgam, 60–61 in foods, 67 Mercury vapor, 61 Methemoglobinemia, 118 Minors, 49–51, 51t Morning sickness, 22t, 34–35 Mother-to-infant transmission of oral pathogens, 22t, 39f, 39–40 Mouthwash, 65 Moxatag See Amoxicillin Multiple births, 10 Myocardial contractility, 30 N Naproxen, 91 National Maternal and Child Oral Health Resource Center, 145 Nausea and vomiting during pregnancy description of, 22t, 34–35 oral care after, 66 Necessary dental treatment, Necrotizing enterocolitis, 91 Nerve blocks, 78 New York State Department of Health, 2, 145 Nitrous oxide description of, 128–129 trimester-based recommendations for, 13t, 129 Nonsteroidal anti-inflammatory drugs, 86 Norco See Hydrocodone + acetaminophen Nosebleed, 44 NSAIDs See Nonsteroidal anti-inflammatory drugs Nursing FDA Pregnancy and Lactation Labeling Rule, 78, 80–82, 81t health benefits of, 69 maternal medication transfer to infant during, 49 medication use during, 78 150 www.pdflobby.com Ninan_Index.indd 150 2/28/18 11:40 AM Index opioid use during, 87 Nutritional counseling, 66–67 Nutritional deficiencies, 22t, 35 NVP See Nausea and vomiting during pregnancy O Obstructive cholestasis, 38 Opioids, 87 Oral care at-home, 64–66 for infant, 69 Oral cavity, 23t, 41–43 Oral health assessment of, 11–12 California Dental Association evidencebased guidelines for, prenatal care provider discussions about, Oral hygiene, in third trimester, 14 Oral pathogens, mother-to-infant transmission of, 22t, 39f, 39–40 Oral pathologies, Organic mercury, 60, 67 Organogenesis, 48 Over-the-counter medications, 79 Oxycodone + acetaminophen, 88t, 99 Oxycodone + aspirin, 98 P Palmar erythema, 23t, 40 Parity, 10 Patient education, 12–14, 13t Patient perceptions, Patient positioning left uterine displacement, 21t, 26, 30–32, 32f, 52 in second trimester, 12 supine position, 30 Penicillin V potassium, 102t, 103 Penicillins, 102t Perceptions dental provider, patient, prenatal care provider, 1–2 Percocet See Oxycodone + acetaminophen Perimylolysis, 23t, 41 Periodontal disease description of, 1, 20 gestational diabetes and, 33 preeclampsia and, 26 pregnancy outcomes affected by, 63 respiratory infections and, 44 Periodontal treatment, 13t Physiologic changes, 20–23, 21t–22t Placental abruption, 27 PLLR See Pregnancy and Lactation Labeling Rule Polocaine See Mepivacaine Postpartum period dental care in, 14 hypercoagulable state in, 37, 122–123 local anesthetic use in, 122–123 PRCs See Pregnancy risk categories, FDA Predifferentiation, 48 Preeclampsia, 21t, 26–27 Preexisting hypertension, 29 Pregnancy and Lactation Labeling Rule, 78, 80–82, 81t Pregnancy granuloma, 42 Pregnancy risk categories, FDA, 78–82 Pregnancy tumor, 42 Pregnancy-induced hypertension, 29 Premature birth, 49 Prenatal care provider perceptions, 1–2 Prescription writing, 143 Prilocaine, 116t, 126 Principles of teratology, 46 Progesterone, 20, 30, 32, 43 Prophylaxis, dental, 63–64 Psychogenic reactions, 117–118 Pulmonary embolism, 37 Pyogenic granuloma, 23t, 42 Pyrosis, 22t, 33–34 Q Quinolones, 102t R Radiation exposure, 57–59 Radiographs administrative requirements for, 59 dental treatment effects of, 59 FDA recommendations for, 141–142 indications for, 57, 141–142 insurance requirements for, 59 radiation exposure from, 57–59 reasons for taking, 59–60 trimester-based recommendations for, 12, 13t Rapid satiety, 33 Renal system, 23t, 43 Reproductive history, 10 Reproductive system, 23t, 43–44 Respiratory alkalosis, 45 151 www.pdflobby.com Ninan_Index.indd 151 2/28/18 11:40 AM Index Respiratory capacity, 23t, 46 Respiratory system, 23t, 44–46, 45 Root planing See Scaling and root planing S Safety considerations, 7–9 Salivary changes, 23t, 42–43 Scaling and root planing, 63–64 Scandonest See Mepivacaine Screening oral health, 11–12 reproductive history, 10 SDF See Silver diamine fluoride Second trimester, 12–14, 13t Seizures, eclamptic, 28–29 Sensorcaine See Bupivacaine Septocaine See Articaine Shortness of breath See Dyspnea Silver diamine fluoride, 70–71 Sodium bisulfite, 117t Sodium fluoride, 14 Spider angioma, 23t, 40 Spontaneous abortion, 12, 48, 58 SRP See Scaling and root planing Stochastic effects, of radiation, 58 Streptococcus mutans, 39, 39f, 68 Subacute bacterial endocarditis, 30 Supine hypotension, 12 Supine hypotensive syndrome, 21t, 30–31 Supine position, 30, 32f Systolic blood pressure, 29 T Thyroid gland, 58 Tissue factor, 37 Toothbrushes, 65 Toothpaste for children, 71t, 71–72, 72f fluoride-containing, 72 in pregnancy, 65 Topical anesthetics, 116t, 118–121 TPAL, 10 Tramadol + acetaminophen, 96 Treatment See Dental treatment Tylenol See Acetaminophen; Acetaminophen + codeine Type diabetes mellitus, 32 Type diabetes mellitus, 21t, 32 U Upper respiratory mucosa, 23t, 44 Urgent dental treatment, 6, 13t Urinary system, 23t, 43 Urination, 43 Uterine spinal arteries, 28 V Vicodin See Hydrocodone + acetaminophen Vicoprofen See Hydrocodone + ibuprofen Vital capacity, 46 Vivacaine See Bupivacaine Vomiting See Nausea and vomiting during pregnancy W Teenage pregnancy See Adolescent pregnancy Teeth development of, 47 infant’s, cleaning of, 71 Teratogens, 46–48, 52, 58 Tetracaine, 116t, 120 Tetracyclines, 102t TF See Tissue factor Thalidomide, 47 Third trimester, 14, 31 Thromboembolic disease, 22t, 36–38 Water, 67 Web resources, 144–145 World Health Organization mercury intake standards, 60 X Xylitol, 67–69 Z Zithromax See Azithromycin 152 www.pdflobby.com Ninan_Index.indd 152 2/28/18 11:40 AM www.pdflobby.com .. .Dentistry and the Pregnant Patient www.pdflobby.com Ninan_Frontmatter.indd 2/28/18 11:23 AM www.pdflobby.com Ninan_Frontmatter.indd 2/28/18 11:23 AM Dentistry Pregnant Patient and the Daniel... dental treatments In addition to the risk to the mother, there is also the risk to the baby However, providing treatment that benefits the mother may also benefit the baby www.pdflobby.com Ninan_CH02.indd... pregnancy 3–16 The decision of whether to perform dental treatment in a hospital or an outpatient dental office setting will depend on the patient? ??s health and the type and extent of the oral pathology.15